Sr. Consultant, Liver Transplant, HPB & GI Surgery, Metro Heart Institute with Multispeciality, Faridabad
Part 3 of 10 in Diagnosis and Management of Liver Cirrhosis
Diagnosing Cirrhosis Early: Fibroscan Before Symptoms Appear
June 16, 2024
The most important thing to understand about cirrhosis is that early cirrhosis has no symptoms at all, which is why catching it depends entirely on proactive testing rather than waiting for signs.
Fibroscan and biopsy
Patients with risk factors, such as long-term alcohol use, hepatitis B or C, diabetes, or obesity, should be monitored with regular liver function tests, a complete blood count, kidney function tests, prothrombin time, and an abdominal ultrasound. A fibroscan or, less commonly now, a liver biopsy can detect fibrosis or cirrhosis before symptoms develop; biopsy is not required in 99% of cases to diagnose cirrhosis itself. If the disease is still at the stage of steatohepatitis (fatty liver inflammation without fibrosis), controlling risk factors can make it fully resolve; once cirrhosis has developed, the liver will not become normal again even if the underlying cause, such as a virus, is eliminated.
Why late diagnosis is easy but too late
By contrast, advanced cirrhosis is easy to diagnose clinically: jaundice, ascites (fluid in the abdomen), leg oedema, spider angiomas, palmar erythema and gynaecomastia are its telltale signs, along with muscle wasting. But these only appear once cirrhosis is already advanced, which is why an ultrasound or fibroscan done proactively, before symptoms appear, is the better approach to catching the disease early.
This article is based on a Jivo Masterclass session conducted by Dr. Sandeep Jha, Consultant Liver Transplant, Manipal Hospital, New Delhi. The article has been summarised with the assistance of an AI tool from the original masterclass recording. Watch the full Masterclass recording
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This guide is based on a live Jivo Masterclass: Dr. Sandeep Jha taught doctors across Africa on June 16, 2024.
FROM THE LIVE Q&A
Jivo Doctor Partner (name unclear from transcript)
Can hepatitis B be permanently cured with current drugs?
Dr. Sandeep Jha
Today's drugs are excellent compared to 10 years ago and can control the virus very effectively. However, they cannot permanently cure hepatitis B, because the virus hides inside cells and can reactivate even after years or decades.
Frequently Asked Questions
Do all patients with liver cirrhosis go on to develop features of decompensation?▼
No, absolutely not. About 5% of cirrhosis patients decompensate every year. If cirrhosis is diagnosed early and risk factors are controlled (weight loss, diabetes control, hepatitis B/C control), there is a good chance the patient can live out their life with the same liver. However, there is no way to know in advance how long a given cirrhotic liver will last, which is why patients are placed under six-monthly surveillance instead.
How is the progression from fatty liver to cirrhosis diagnosed and managed?▼
The first step is to determine whether cirrhosis has actually developed, using a fibroscan or, less often now, a liver biopsy. If the disease is only at the steatohepatitis stage (fatty liver inflammation with no fibrosis yet), controlling risk factors can make it fully resolve. If cirrhosis has already developed, the patient is kept under regular monitoring, since there is no way to predict when a cirrhotic liver will start to fail.
What are the exam findings of cirrhosis, and when do they appear?▼
On examination, jaundice, ascites, leg oedema, spider angiomas, palmar erythema and gynaecomastia are the telltale signs of cirrhosis. Unfortunately, these are only seen in advanced cirrhosis. Since the goal is to catch cirrhosis before complications develop, an ultrasound or fibroscan done proactively is the better approach for early diagnosis.
What are the effective drugs for hepatitis B and C?▼
For hepatitis B, tenofovir and entecavir are very effective drugs with low resistance levels that can practically control the virus. For hepatitis C, directly-acting agents such as sofosbuvir and velpatasvir are very effective and can practically eliminate the virus from the body.
What is the donor's recovery timeline after living donor liver transplant?▼
The donor is admitted for about seven days. By the third or fourth day, the donor is walking around, eating, and relatively pain-free, and is discharged by day six or seven. A follow-up OPD visit happens on day 10; if doing fine, the donor can return to their home country and resume office and light household work, with the only restriction being on lifting heavy weights.
How is early cirrhosis diagnosed, since it has no symptoms?▼
Through proactive testing in at-risk patients: liver function tests, ultrasound, and a fibroscan, which can detect fibrosis or cirrhosis before any symptoms develop.
What are the visible signs of advanced cirrhosis?▼
Jaundice, ascites, leg oedema, spider angiomas, palmar erythema, gynaecomastia and muscle wasting - but these only appear once the disease is already advanced.
In This Series: Diagnosis and Management of Liver Cirrhosis
- 1.Liver Cirrhosis
- 2.What Causes Liver Cirrhosis: Hepatitis, Alcohol and NAFLD
- 3.Diagnosing Cirrhosis Early: Fibroscan Before Symptoms Appear
- 4.MELD and Child-Pugh Scores: Grading Cirrhosis and Timing a Transplant
- 5.Decompensated Cirrhosis: Ascites, Encephalopathy and Liver Failure
- 6.Living Donor vs Deceased Donor Liver Transplant
- 7.Living Liver Donor Safety and Evaluation
- 8.Liver Transplant Recovery: Donor and Recipient Timelines
- 9.Hepatitis B and C: Treatment and Family Precautions
- 10.NAFLD and Metabolic Risk Factors: Diet and Lifestyle Management